Electronic health information tools for patients, including patient-accessible Electronic Medical Records (EMRs) and Personal Health Records (PHRs) are proliferating in both large and small practices and health care delivery systems nationally and this will surely accelerate due to the Obama Administration's commitment to eHealth. Given that 50% of the adult population reads at the 8th grade level and lower, and millions of adults have low or inadequate health literacy, we can assume that many aspects of these systems are "high-barrier" and hard to read and use. However, there has been very limited systematic end-user assessment of these systems with low-literacy patients. This proposed exploratory R21 research is being done in collaboration with the New York City Department of Health and Mental Hygiene which is promoting the adoption of a patient-accessible EMR primarily among providers who care for underserved patients. Our target population is adults who are low income, low-education level, low-literacy, predominantly minority adults living in Harlem, NYC. The targeted health domain will be cancer prevention and management. Aim 1: conduct patient-centered research on a representative sample of patient-accessible EMRs with a focus on three core functions: 1) Medication Management, 2) Lab/Test Results, and 3) Health Maintenance (e.g., reminders for screenings). Our research will be based on a user-centered design approach including: health literacy load analysis;focus groups;task analysis;and usability testing. We will perform these analyses of these core functions using a sample of patient-accessible EMRs that are in wide-spread use in the United States and vary in structure and interface design. Aim 1(a): understand patients'perceptions of the perceived utility of EMRs and the specific functions associated with these systems, and identify factors that influence patients'acceptance of these systems. In addition, we will gather information on patients'concerns about the adoption of EMRs. Aim 2: develop preliminary guidelines for content, design, testing, and introducing patient-accessible EMRs for underserved and at-risk populations that can be evaluated in a future larger-scale effectiveness study. The preliminary guidelines that result from the proposed research will also be useful to public health officials working to adopt patient-accessible EMRs, provider practices and hospitals, and software developers. Our long term goal is to demonstrate in a comparative trial that EMRs that are informed by a rich model of health literacy and usability principles will result in better patient understanding and use of these systems and improvements in health status. PUBLIC HEALTH RELEVANCE: We propose to study, and develop preliminary guidelines for, the readability and usability of patient-accessible electronic medical records (EMRs) by low average and low literacy patients, a topic about which little is known. This project is particularly timely, both because of the Obama Administration's commitment to eHealth and because the New York City Department of Health and Mental Hygiene, as part of a $27 million Mayoral initiative to improve the quality and efficiency of health care in New York City, is supporting the adoption of a patient-accessible EMR primarily among providers who care for patients who live in neighborhoods of great health disparities, which have a disproportionate number of low literacy patients. Our target population is adults who are low-medium income, low-educated, low-literate predominantly minority urban dwellers residing in Harlem, New York City.